What is the treatment regimen for tetanus?

From the Guidelines

The treatment regimen for tetanus involves administering human tetanus immune globulin (TIG) at a dose of 250 units intramuscularly for adult and pediatric patients, as recommended by the most recent guidelines 1.

Key Considerations

• The decision to administer TIG should be based on the primary vaccination history for tetanus, with consideration of the wound type and patient's immunization status 1.
• For patients with unknown or uncertain previous tetanus vaccination histories, TIG is indicated, and the products should be administered using separate syringes at different anatomical sites 1.
• Wound debridement is essential to remove the source of infection, and antibiotic therapy may be considered in certain cases.

Treatment Approach

• TIG administration: 250 units intramuscularly for adult and pediatric patients, as recommended by the CDC 1.
• Wound management: debridement and cleaning of the wound to prevent further infection.
• Supportive care: may include intensive care with mechanical ventilation, cardiac monitoring, and management of autonomic instability, as well as nutritional support and deep vein thrombosis prophylaxis.

Special Considerations

• Patients with HIV infection or severe immunodeficiency who have contaminated wounds should also receive TIG, regardless of their history of tetanus immunizations 1.
• Persons with a history of an Arthus reaction following a previous dose of a tetanus toxoid–containing vaccine should not receive a tetanus toxoid–containing vaccine until >10 years after the most recent dose 1.

From the FDA Drug Label

In some conditions, e.g., tetanus, larger doses may be required. For tetanus, larger doses may be required. For tetanus in infants over 30 days of age, 1 mg to 2 mg intramuscular or intravenous, slowly, repeated every 3 to 4 hours as necessary. In children 5 years or older, 5 mg to 10 mg repeated every 3 to 4 hours may be required to control tetanus spasms Respiratory assistance should be available.

The treatment regimen for tetanus using Diazepam involves:

• Infants over 30 days of age: 1 mg to 2 mg intramuscular or intravenous, slowly, repeated every 3 to 4 hours as necessary.
• Children 5 years or older: 5 mg to 10 mg repeated every 3 to 4 hours may be required to control tetanus spasms. Respiratory assistance should be available 2.

From the Research

Tetanus Diagnosis and Treatment Guidelines

• Tetanus is a preventable illness that occurs worldwide with a high mortality rate, mostly affecting neonates in developing countries 3.
• The diagnosis of tetanus is clinical, and the effects are toxin mediated 3.
• The mainstays of tetanus management include:
  • Antibiotics
  • Antitoxin
  • Immunoglobulin
  • Wound care 3
• Magnesium sulphate therapy may be used to control muscle spasms in tetanus patients, but its efficacy in severe cases is limited 4.
• Intrathecal administration of tetanus antitoxin may be beneficial in reducing the need for mechanical ventilation in patients with tetanus, but further studies are needed to confirm this 5.
• Tetanus presentation can vary, but common symptoms include trismus and rigidity in the abdomen, neck, back, or extremities 6.
• Laboratory results and cultures are of little diagnostic value, so timely recognition of the clinical presentation is important 6.
• Preventing tetanus should be a high priority for all primary care physicians, and active immunization with tetanus toxoid is remarkably effective and safe 7.
• Passive immunization with human tetanus immune globulin is indicated in certain circumstances, such as in patients who have not been vaccinated or have a weakened immune system 7.